Provider Demographics
NPI:1992717136
Name:BENNER PIKE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:BENNER PIKE CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARRARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-355-1119
Mailing Address - Street 1:2820 BENNER PIKE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823
Mailing Address - Country:US
Mailing Address - Phone:814-355-1119
Mailing Address - Fax:814-353-9144
Practice Address - Street 1:2820 BENNER PIKE
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823
Practice Address - Country:US
Practice Address - Phone:814-355-1119
Practice Address - Fax:814-353-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003514L111N00000X
PADC008872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010880500003Medicaid
PAT29857OtherHEALTH AMERICA
PA167853OtherBCBS
PA167853KNEMedicare ID - Type Unspecified
PA0010880500003Medicaid
PAT29857OtherHEALTH AMERICA
PA701297Medicare PIN